Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2021 Aug;81(11):728-735. doi: 10.1002/pros.24169. Epub 2021 May 19.
To test for rates of other cause mortality (OCM) and cancer-specific mortality (CSM) in elderly prostate cancer (PCa) patients treated with the combination of radical prostatectomy (RP) and external beam radiation therapy (EBRT) versus RP alone, since elderly PCa patients may be over-treated.
Within the Surveillance, Epidemiology and End Results database (2004-2016), cumulative incidence plots, after propensity score matching for cT-stage, cN-stage, prostate specific antigen, age and biopsy Gleason score, and multivariable competing risks regression models (socioeconomic status, pathological Gleason score) addressed OCM and CSM in patients (70-79, 70-74, and 75-79 years) treated with RP and EBRT versus RP alone.
Of 18,126 eligible patients aged 70-79 years, 2520 (13.9%) underwent RP and EBRT versus 15,606 (86.1%) RP alone. After propensity score matching, 10-year OCM rates were respectively 27.9 versus 20.3% for RP and EBRT versus RP alone (p < .001), which resulted in a multivariable HR of 1.4 (p < .001). Moreover, 10-year CSM rates were respectively 13.4 versus 5.5% for RP and EBRT versus RP alone. In subgroup analyses separately addressing 70-74 year old and 75-79 years old PCa patients, 10-year OCM rates were 22.8 versus 16.2% and 39.5 versus 24.0% for respectively RP and EBRT versus RP alone patients (all p < .001).
Elderly patients treated with RP and EBRT exhibited worrisome rates of OCM. These higher than expected OCM rates question the need for combination therapy (RP and EBRT) in elderly PCa patients and indicate the need for better patient selection, when combination therapy is contemplated.
为了测试接受根治性前列腺切除术（RP）联合外照射放疗（EBRT）与单纯 RP 治疗的老年前列腺癌（PCa）患者的其他原因死亡率（OCM）和癌症特异性死亡率（CSM）的发生率，因为老年 PCa 患者可能接受过度治疗。
在监测、流行病学和最终结果数据库（2004-2016 年）中，通过倾向评分匹配 cT 期、cN 期、前列腺特异性抗原、年龄和活检 Gleason 评分，以及多变量竞争风险回归模型（社会经济地位、病理 Gleason 评分），对接受 RP 和 EBRT 与单纯 RP 治疗的 70-79 岁、70-74 岁和 75-79 岁患者的 OCM 和 CSM 进行了累积发生率图分析。
在 18126 名符合条件的 70-79 岁患者中，2520 名（13.9%）接受了 RP 和 EBRT，而 15606 名（86.1%）仅接受了 RP。经过倾向评分匹配后，10 年 OCM 发生率分别为 RP 和 EBRT 组 27.9%和单纯 RP 组 20.3%（p < 0.001），多变量 HR 为 1.4（p < 0.001）。此外，RP 和 EBRT 组 10 年 CSM 发生率分别为 13.4%和 5.5%。在分别针对 70-74 岁和 75-79 岁 PCa 患者的亚组分析中，10 年 OCM 发生率分别为 22.8%和 16.2%和 39.5%和 24.0%，均为 RP 和 EBRT 组高于单纯 RP 组（均 p < 0.001）。
接受 RP 和 EBRT 治疗的老年患者 OCM 发生率令人担忧。这些高于预期的 OCM 发生率质疑了在老年 PCa 患者中联合治疗（RP 和 EBRT）的必要性，并表明在考虑联合治疗时需要更好的患者选择。
